Bottom Line:
Further evaluation confirmed multi-organ disease with involvement of lungs, intrathoracic lymph nodes, and the central nervous system.This case report shows that diagnosis of a severe disease can be missed if systematic clinical signs are not given.Furthermore, an accurate anamnesis and examination is required to receive an early diagnosis which often needs an interdisciplinary approach.

Background: Sarcoidosis is a granulomatous disease that may affect any organ of the body. The most frequent loci of manifestation are the lungs. However, there are individual cases where bones are affected. The literature describes cases in which swelling or fistula were the first findings of a bone lesion. This is the first case reporting an osteolysis in both angles of the mandibles which led to the diagnosis of sarcoidosis with multi-organ involvement.

Case presentation: The authors present a 74 years old European female patient without previous diagnosis of sarcoidosis who presented with pain in the area of the jaw angles. There were no further clinical symptoms. Bone biopsy following radiological investigation demonstrated non-caseating granulomas consistent with sarcoidosis of the bone. Further evaluation confirmed multi-organ disease with involvement of lungs, intrathoracic lymph nodes, and the central nervous system.

Conclusion: This case report shows that diagnosis of a severe disease can be missed if systematic clinical signs are not given. Furthermore, an accurate anamnesis and examination is required to receive an early diagnosis which often needs an interdisciplinary approach.

Fig1: Panoramic X-ray. The arrows on the panoramic X-ray show osteolytic zones on the right and left angle of the lower jaw

Mentions:
A 74 year old European female patient approached her dentist due to pain in the right lower jaw. A panoramic X-ray was performed, presenting an osteolysis of unknown origin in the mandible on both sides, right more than left (Fig. 1). The patient was then referred to the clinic of cranio-maxillo-facial surgery for further evaluation. She reported pain in the area of the right angle of the mandible for several months; additionally, pain in the right calcaneus and in both forearms has been noted. She denied fever and weight loss, but reported cough and dyspnoea on exertion. Furthermore, a sicca-symptomatic in both eyes and the oral cavity was present. The patient was diagnosed with hypertensive cardiac disease, rhytmogene cardiopathy, hyperlipidaemia, cutaneous psoriasis with psoriasis arthritis, and lumbar vertebral syndrome several years before. Her home medication included pantoprazol, candesartane, acetylsalicylate, spironolactone, and simvastatine.Fig. 1

Fig1: Panoramic X-ray. The arrows on the panoramic X-ray show osteolytic zones on the right and left angle of the lower jaw

Mentions:
A 74 year old European female patient approached her dentist due to pain in the right lower jaw. A panoramic X-ray was performed, presenting an osteolysis of unknown origin in the mandible on both sides, right more than left (Fig. 1). The patient was then referred to the clinic of cranio-maxillo-facial surgery for further evaluation. She reported pain in the area of the right angle of the mandible for several months; additionally, pain in the right calcaneus and in both forearms has been noted. She denied fever and weight loss, but reported cough and dyspnoea on exertion. Furthermore, a sicca-symptomatic in both eyes and the oral cavity was present. The patient was diagnosed with hypertensive cardiac disease, rhytmogene cardiopathy, hyperlipidaemia, cutaneous psoriasis with psoriasis arthritis, and lumbar vertebral syndrome several years before. Her home medication included pantoprazol, candesartane, acetylsalicylate, spironolactone, and simvastatine.Fig. 1

Bottom Line:
Further evaluation confirmed multi-organ disease with involvement of lungs, intrathoracic lymph nodes, and the central nervous system.This case report shows that diagnosis of a severe disease can be missed if systematic clinical signs are not given.Furthermore, an accurate anamnesis and examination is required to receive an early diagnosis which often needs an interdisciplinary approach.

Background: Sarcoidosis is a granulomatous disease that may affect any organ of the body. The most frequent loci of manifestation are the lungs. However, there are individual cases where bones are affected. The literature describes cases in which swelling or fistula were the first findings of a bone lesion. This is the first case reporting an osteolysis in both angles of the mandibles which led to the diagnosis of sarcoidosis with multi-organ involvement.

Case presentation: The authors present a 74 years old European female patient without previous diagnosis of sarcoidosis who presented with pain in the area of the jaw angles. There were no further clinical symptoms. Bone biopsy following radiological investigation demonstrated non-caseating granulomas consistent with sarcoidosis of the bone. Further evaluation confirmed multi-organ disease with involvement of lungs, intrathoracic lymph nodes, and the central nervous system.

Conclusion: This case report shows that diagnosis of a severe disease can be missed if systematic clinical signs are not given. Furthermore, an accurate anamnesis and examination is required to receive an early diagnosis which often needs an interdisciplinary approach.